Introduction to Heart Transplantation

The idea  of replacing a bad organ with a good one has been documented in ancient mythology. The first real organ transplants were probably skin grafts that may have been done in India as early as  the second century B.C. The first  heart transplant in any animal  is credited  to Vladimer Demikhov. Working in Moscow in 1946, Demikhov switched  the hearts between two dogs. The dogs survived  the surgery. The first heart transplant in human beings was done in South Africa in 1967 by Dr. Christiaan Barnard; the patient only lived 18 days. Most of the research  that led to successful heart transplantation took place in the United States at Stanford University under the leadership of Dr. Norman Shumway. Once Stanford started reporting better results,  other centers started doing heart transplants. However, successful transplantation of  a human  heart was not ready for widespread clinical application until medications were developed to prevent the recipient from "rejecting" the  donor heart. This happened  in 1983 when the Food and Drug Administration (FDA) approved  a drug called cyclosporine (Gengraf, Neoral). Before the advent of cyclosporine, overall results of  heart transplant were not very good. 

What is a heart transplant?

Believe it or not, heart transplantation is a relatively simple operation for a cardiac surgeon. In fact,  the procedure actually consists of three operations. 

The first operation is harvesting  the heart from  the donor.  The donor  is usually an unfortunate person who has suffered irreversible brain injury, called "brain death". Very often these are patients who have had major trauma  to the head, for example, in an automobile accident. The victim's organs, other than the brain, are working well with the help of medications  and other "life support" that may include a respirator or other devices. A team  of physicians, nurses, and technicians goes to  the hospital of the donor  to remove donated organs once brain death of the donor has been determined. The removed organs are transported on ice to keep them alive until they can be implanted. For the heart, this is optimally less  than six hours. So, the organs are often flown by airplane or helicopter  to the recipient's hospital. 

The second operation is removing the recipient's damaged heart. Removing the damaged heart may  be very easy or very difficult, depending  on whether the recipient has had previous heart  surgery (as is often the case). If there has been previous surgery, cutting through the scar tissue may prolong and complicate removal of the heart. 

The third operation is probably  the easiest; the implantation of the donor heart. Today, this operation basically involves the creation of only five lines of stitches, or "anastomoses". These suture lines connect the large blood vessels entering and leaving the heart. Remarkably, if there  are no complications, most patients who have had  a heart transplant are home about one week after the surgery.

It is the generosity of donors and their families which makes organ transplantation possible.